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Prioritisation: the new growth of the NHS

BMJ 2001; 322 doi: (Published 24 February 2001) Cite this as: BMJ 2001;322:499
  1. Brian McCloskey, faculty of health and exercise sciences,
  2. Daphne Austin, department of public health
  1. University College Worcester, and
  2. Worcestershire Health Authority

    As medical students gathered around a patient's bed in the 1970s and 1980s we were under orders never to use the word “cancer.” We could say “new growth,” “neoplasm,” or, for the more linguistically ambitious, “mitotic lesion,” but not “cancer.” To say the word would frighten the patient unnecessarily. By extension, not to say the word would make everything all right. There was almost a sense that if we did not say the word the problem would go away.

    The public will quickly learn that prioritisation has the same effect as rationing

    Discussing cancer openly and honestly was much more sensible and humane

    Now in the 21st century we have a parallel problem emerging. The NHS cannot say the word “rationing.” We can say “prioritisation,” we can talk of “difficult choices,” and the lexicographically ambitious can say “rational decision making.” But we must not say “rationing.” Are we succumbing to the same myth that if we do not say the word the …

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